[Immuno-hemolytic transfusion reactions. III. Report of 61 cases]. / Les accidents immuno-hémolytiques transfusionnels. III. Etude de 61 cas.

Blood transfusion is mainly bound to immunological and infectious risks. The immunological risk originates from an incompatibility between the blood of the donor and that of the recipient; this risk remains insufficiently assessed. A multicentre study has been carried out by the French Blood Transfusion Society and the National Institute for Blood Transfusion. Sixty-one accidents due to an erythrocyte incompatibility were found: 26 cases with ABO incompatibility, and 35 cases with alloantibodies of other blood group systems. For the former category of accidents, the most frequent cause was due to a failure in the realization of the bedside ABO check. For the latter, the main problem was the achievement and the interpretation of antibody screening. The long term follow-up shows no chronic after-effects of immunological accidents. For each accident, errors have been identified and analysed. It was proven that they all originate from health care establishments.

[Comparative study of the efficacy and tolerability of 2 plasma substitutes used as vascular-loading solutions during plasma exchange]. / Etude comparative de l'efficacité et de la tolérance de deux substituts de plasma utilisés comme solutions de remplissage au cours des échanges plasmatiques.

A 4% human albumin solution in association with colloids was tested in an attempt to reduce the cost of replacement fluids during plasma exchange. In a retrospective study, from May 1988 to December 1989, the efficiency and tolerance of gelatin (Plasmion) and dextran 40 (Plasmacair) were compared. Since June 12, 1989, dextran 40 infused only after administration of dextran 1000 (Promit). Seven hundred and forty eight plasma exchanges were performed in 75 patients; 37 received gelatin (7.24 plasma exchanges/patient), 50 dextran (9.6 plasma exchanges/patient) and 12 both solutions after clinical evidence of intolerance to gelatin. No reaction was noted with dextran 40 used alone or in association with haptenic prevention. The gelatin solution induced 2 immediate allergic reactions and one delayed cutaneous reaction. No cross-reactive allergy was observed between the 2 colloids. Dextran 1000 injections were well tolerated. Gelatin infusions were associated with 10 times more episodes of hypovolemia (5.6 versus 0.62%). This difference is probably linked to a faster elimination of gelatin from the vascular compartment and necessitates the infusion of a larger volume of gelatin, as compared to dextran 40, for the same volume of plasma exchanged.